We are happy to provide our office forms online for your convenience. Questions about which forms you need? Please call our office and our courteous staff will assist you.
Online Fillable Forms
These forms are available as "Fillable" on-line forms - for these just complete and click submit and they will be safely and confidentially received (in a HIPAA compliant manner).
- Patient Portal Signup >>> Spanish Patient Portal Signup >>>
- Patient Registration Forms - English and Spanish [ PDF ] [ Online Form - English ] [ Online Form - Spanish ]
- Authorization for Release of Information [ PDF ] [ Online Form ]
- Authorization for Non-Parent Consent for Treatment of Minor Child [ PDF ] [ O nline Form ]
- Child Intake (4 to 15 years old) [ Online Form - English ] [ Online Form - Spanish ]
- Adolescent Intake (12-21 years old) [ PDF ] [ Online Form ]
- Sports Physical - Parent History Form [ PDF ] [ Online Form ]
- ADHD Parent Vanderbilt Forms [ PDF ] [ Online Form ]
- Baby Pediatrics Symptoms Checklist (BPSC) [ Online Form ]
- Preschool Pediatric Symptom Checklist (PPSC) [ Online Form ]
Forms to Download
These forms are available to download, print and complete and could be scanned and sent back by portal message or brought into clinic.
New Patient Forms
- Patient Registration Forms - English and Spanish [ PDF ] [ Online Form - English ] [ Online Form - Spanish ]
- Notice of Privacy Practices
- Financial Policy English- Spanish
- Missed Appointment Policy - English and Spanish
- Consent to Treat Minors - English and Spanish
- Child Family Profile - English and Spanish
- Authorization for Release of Information [ PDF ] [ Online Form ]
- Mutual Exchange of Information
- Authorization for Non-Parent Consent for Treatment of Minor Child [ PDF ] [ O nline Form ]
COVID Vaccine Appointment Forms
Well Child Forms
- Well Child Visit form (4 to 15 years old) [ Online Form - English ] [ Online Form - Spanish ]
- Adolescent Intake (12-21 years old) [ PDF ] [ Online Form ]
- Preparticipation Physical Evaluation [ PDF ] [ Online Form ]
- Skagit Pediatrics Teen Letter
- Spanish Teen Letter
School Forms
- Certificate of Immunization Exemption
- Authorization for Administration of Medication at School - English and Spanish
Behavioral Health Forms
- Kara K. Smith, LSWAIC Disclosure
- Patricia E. Beagle, LSWAIC Disclosure
- Child Intake (4 to 15 years old) [ Online Form - English ] [ Online Form - Spanish ]
- Adolescent Intake (12-21 years old) [ PDF ] [ Online Form ]
- Baby Pediatrics Symptoms Checklist (BPSC) [ Online Form ]
- Preschool Pediatric Symptom Checklist (PPSC) [ Online Form ]
- PHQ-9 Spanish
- GAD-7 Spanish
- FAST - Anxiety
- FAST - Behavior
- FAST - Depression
- FAST - Parenting Teens
- Crisis Prevention Plan
- Spanish FAST - Anxiety
- Spanish FAST - Behavior
- Spanish FAST - Depression
- Spanish Crisis Prevention
ADHD/ADD/Behavior - PARENT PACKET
- ADHD Initial Evaluation Letter
- ADHD/Behavior Caregiver Summary of Concerns
- ADHD Parent Vanderbilt Forms [ PDF ] [ Online Form ]
- ADHD Parent Vanderbilt Form Spanish
- Pediatric Symptom Checklist English/Spanish
- Consent for Mutual Exchange of Information
ADHD/ADD/Behavior - TEACHER/COUNSELOR PACKET
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